 The act of defecation involves a very private sphere, and is the object of cultural taboo so much so that it's rarely thought of even by physicians. But it should be. A constipation accounts for 3 million annual visits to doctors in the United States and 800,000 emergency room visits. Depending on how you define it, up to 80% of the population may be suffering. Even people who don't think they're constipated may very well be clinically constipated. A quarter of their so-called healthy subjects reported experiencing incomplete emptying, and approximately half indicated increased straining. In fact, more than a half had found blood on their toilet paper within the past year. In severe cases, the blood pressure spike associated with straining its stool can even trigger a heart attack or stroke. There aren't drugs for it. There are always drugs, resulting in side effects like headache, nausea, diarrhea, and abdominal pain, leaving most patients unsatisfied. People want to instead just try to treat the cause. Common causes of chronic constipation include lack of adequate whole-plant foods or insufficient water intake. So making changes in the patient's diet and lifestyle is the preferred method for relieving constipation. Such non-pharmacological clinical effective interventions, including engaging in physical activity for about 30 minutes a day. A systematic review and meta-announce has found aerobic exercise interventions help. We're starting at about 140 minutes a week, and then of course a diet-centered around whole-plant foods, which are the only naturally concentrated sources of fiber. Any plants in particular? If you give elderly women with severe constipation about a dozen prunes a day, the experience significant improvement within the first week. The control group in the study wasn't told to do anything though, and any time you have one group doing something and the other doing nothing, you can't discount the placebo effect. And the placebo response for constipation trials can range up to 44%, meaning up to nearly half of the people given a sugar peel claim to experience an improvement. So that's why we need studies like this. Subjects were randomized to about 8 prunes a day, plus a large glass of water, 12 prunes in water, or just the water alone. So even the control group got an intervention they were told might help with constipation. Previous studies mostly signed 10 prunes or so a day, so the researchers wanted to see if more was better or less was sufficient. And they found a significant improvement in stool bulk on the prunes and a significant increase in bowel movement frequency, though no real difference between 8 and 12, so 8 a day seems sufficient. Prunes even appear superior to psyllium sold as metamucil, beating it out in terms of improved stool frequency and consistency. We used to think it was just all the fiber in prunes that was helping, but prune juice evidently works too, which like most juices has had the fiber removed. Other potential active components include a natural sugar alcohol known as sorbitol that's used in some sugar-free gum. Once you eat more than a dozen or so large prunes a day, however the dose of sorbitol could start reaching laxative levels in susceptible individuals, so be careful. If you don't have constipation, should you avoid prunes? That's been put to the test, and most people should be able to eat a dozen or so a day without any issues. In fact, it's interesting to note that prunes have been traditionally used as both laxative and an anti-diaryl remedy. What about dried figs? One of the few medicinal plants mentioned explicitly in the Bible. Researchers took patients with a type of irritable bowel syndrome characterized by constipation and randomized them to one fig with breakfast and one fig with lunch, each with a glass of water, and there was significant improvement in frequency of defecation and a significant drop in the frequency of hard stools compared to control. But what was the control? The control group was just asked to continue their normal diet. In other words, to do nothing special, the placebo response for irritable bowel is infamous. Give people with IBS a fake sugar pill, sometimes 72% say they magically feel better. That's why we need this kind of study, a randomized double-blind placebo-controlled trial. Researchers made a gross-sounding fig-paste placebo that supposedly had the same taste smell and appearance as the real deal. Those who got the real figs, about six a day, seemed to improve colon transit time, stool consistency, and abdominal discomfort compared to the placebo. Researchers measured transit time by having people swallow little beads that would show up on x-rays so they could track the progress through the digestive system. They found that those eating the real figs sped up their gut movement by a full 24 hours. Defecation frequency per week didn't beat out placebo, though. In fact, they tested so many different outcomes, even the stool consistency and tummy discomfort results may have been statistical flukes. So it looks like prunes would be the better treatment choice.